Observations and provocations from The Times' Opinion staff

Conservative vs. Liberal: Healthcare

February 20, 2012 | 5:30
am

On Sunday, Charlotte Allen, who describes herself as a conservative somewhere to the right of Pedro the Cruel, and Diana Wagman, a pacifist, vegetarian, Prius-driving, NPR-listening liberal, explained in separate Opinion articles why they have trouble talking to people with different political views. ("Liberals vs. conservatives," "Conservatives vs. liberals.") But we've asked them to try, conducting an exchange of emails on the issues of gay marriage and healthcare. Here is their correspondence on healthcare. On Sunday, we featured their exchanges on gay marriage.

Charlotte Allen to Diana Wagman:

The most crucial issue in the November election, bar none, is repealing "Obamacare." For starters, the individual mandate that requires all Americans to purchase health insurance policies is probably unconstitutional, and it's certain to be rendered pointlessly expensive by all the medical and quasi-medical bells and whistles shoved into the 2,000-page "affordable care" act by various advocacy groups. Under Obamacare we the public have to pay 100% of women's contraceptive costs, even though the vast majority of Americans can't possibly need women's contraceptives (all males, nearly all females younger than 15 and older than 40, plus everyone who either doesn't believe in birth control or finds it creepy to stuff your body with powerful hormones for 25 years). Birth control pills are already cheap at about $30 a month, $5 more than the cost of a pedicure. They're free to many poor and near-poor women.

There's also all the other therapeutic pork. Under Obamacare we've got to pay for "mental health" counseling for those who are feeling blue, and drug and alcohol counseling for those who can't stay off blow and juice. We almost had to pay (until the Health and Human Services Department rescinded its rule) for "end of life" counseling designed to ease old folks into early graves. We've got to pay for "community health centers," some of which will spend taxpayer dollars to treat illegal immigrants no questions asked, and others of which will spend more taxpayer dollars to combat "obesity" (my no-cost advice to the obese: Quit huffing junk food and get some exercise). We're obliged to pay for "visiting nurses" -- i.e. registered nurses paid registered nurses' salaries -- to drop by the homes of welfare mothers and tell them to please change their babies' diapers every now and then and not hit them when they cry.

Yes, we desperately need healthcare reform in America. But we need to go back to square one and start over. Obamacare was a measure that nobody really wanted. It was a Senate compromise measure that was supposed to go back to the House for even more compromises -- until Scott Brown was elected Massachusetts senator in late 2009, making possible a likely Republican filibuster, so the House hastily turned the Senate bill into law under a rules finagle. We need to devise a way, preferably independently of the current employment-based model, to allow people to buy cheap, individually-tailored insurance that covers genuine health emergencies sans politics-driven Christmas trees of politics-driven goodies, and not to have to worry -- via a reinsurance setup? -- about coverage of preexisting conditions when they change jobs.

Wagman to Allen:

Let's first begin with a basic premise: that all Americans should have affordable healthcare. We are the richest country in the world and the only First World nation without universal healthcare. What is so terrifying about every sick child getting penicillin, or every nearsighted person getting glasses? Because someone can't afford the astronomical costs of private health insurance doesn't mean they don't deserve it.

A 2009 study by Johns Hopkins Children's Center said that lack of health insurance was a factor in the deaths of nearly 17,000 children. That's criminal. Talk about class warfare!

The problem isn't the Affordable Care Act paying for contraception (much cheaper than paying for pregnancy and delivery) or mental health and addiction programs, or even private nurses for welfare moms (I can't even respond to that without laughing -- are we back to President Reagan's welfare mother in a Cadillac?). The problem is insurance companies have way too much power and have effectively scared Americans into thinking universal care means we won't be able to see our regular practitioner, we'll have interminable waits and that -- horrors -- some poor person will get the medicine he or she needs and we'll have to pay for it. Blue Cross, Aetna and the rest aren't in the business of wellness; they're just in business. Yes, unfortunately there will be some fraud, but because some people abuse the system is no reason to cancel it for everyone. Some drivers run red lights. That doesn't mean we should make every intersection a free-for-all.

The Affordable Care Act is a great first step. It's not perfect. Social Security wasn't popular when first introduced. Opponents even called it socialism. It was refined over time. President Obama's plan is the right idea. The good far outweighs the bad. Starting over will just give the insurance companies the time they need to keep any reform from happening.

Allen to Wagman:

Deciding to hand out contraceptives -- not just to poor and near-poor women, who already qualify for free birth control, but to middle-class and even wealthy women (the 1%!) with no co-pay -- is not a healthcare decision but a policy decision. Deciding that it's cheaper to pay for birth control than to pay for pregnancy is also a policy decision. Feminists decided that it was sauce for the goose, since men can qualify for free (or at least cheap) Viagra. It's an example of the kind of non-health-related goodies that politicians, egged on by lobbyists for interest groups, have hung on the Obamacare Christmas tree, ballooning the law to its current 2,000-page size.

As for penicillin for sick children and eyeglasses for the nearsighted, they're poor examples of the deficiencies of the pre-Obamacare system. Nearly all states operate programs that provide free penicillin and other life-saving drugs for uninsured sick children whose parents can't afford antibiotics for them. Eyeglasses are dirt-cheap at outfits such as Hour Eyes -- and if you're farsighted, you can buy reading glasses off the rack at any drugstore or supermarket.

Moving on to your allusion to "welfare mothers in a Cadillac." You need to update that figure of speech to "welfare mothers with 103-inch flat-screen TVs." What I was trying to say wasn't that women on welfare get treated to luxuries such as private nurses that most people can't afford. It's that it's a waste of money to send registered nurses (who command high salaries) to the homes of welfare mothers to show them how to take care of their (healthy) babies. Anyone can do that with a modicum of training. I could do it myself because, even though I've never had children, I enjoyed looking after my baby brother when I was 17. But a couple of years ago "nurse-family partnerships" were all the rage as cure-alls for social ills, so they got into the Obamacare law. They're an example of the huge number of pet projects worked into that law that someone has to pay for, either taxpayers or premium payers who are going to find that the Affordable Care Act suddenly isn't so affordable.

Now, about those demon insurance companies. I think you're thinking back to 1994, when insurance companies fought tooth and nail to defeat "Hillarycare," the last Democratic administration effort to impose a government-regulated healthcare scheme on the public. This time around, the big insurance companies did zero to fight back. Indeed, they donated huge sums of money to both Barack Obama's and Hillary Rodham Clinton's presidential campaigns, and they essentially supported both the House and Senate bills as they became law in 2010. The reason is that healthcare demand has soared so far out of control that health insurance companies can't make any money. They've been more than happy to turn themselves into intensely regulated public utilities (under Obamacare) in which the government would ensure them modest profits in return for federal governance. This means that when the government starts to ration care, as it inevitably will, the insurance companies won't have to take the heat.

Finally, those 17,000 dead children whose families lacked health insurance. That study examined the medical records of 23 million hospitalized children. So the 17,000 represents only 0.07% of the total. The study found that children whose families lacked insurance did die at a higher rate than those whose families didn't. But the researchers concluded only that lack of insurance "may have" contributed to the deaths.

Like you, I believe that all citizens of prosperous America should have access to affordable health insurance. One way to start would be to turn health insurance into real insurance -- covering ruinous medical catastrophes, not routine doctor visits or Plan B for college girls who forgot to take their birth control pills. Such insurance would be cheap for the young people who constitute the largest group of those who go without coverage today. If health insurance were decoupled from workplace benefits, people would not have to worry about being denied coverage for preexisting conditions or forgetting that they consulted an acne doctor years ago but forgot to include that on their applications. That would be the beginning of genuine healthcare reform, not the $2-trillion mess that we're stuck with now.

Wagman to Allen:

I agree that healthcare should not be work-related. I agree that all Americans should be able to afford to be healthy. But it's not catastrophic coverage we need but to make routine doctor visits available for everyone. We've made huge strides in preventive medicine. Pap smears, blood tests, mammograms, etc. can catch disease early, before it turns deadly. Preventive care saves pain as well as money. It costs a lot more money to treat someone sick with cancer than to provide him with a colonoscopy and removal of a suspicious polyp.

As for birth control, it is another preventive and used by women across the political and economic spectrum. Why shouldn't it be free for anyone who chooses to use it? That's very egalitarian. And young women are the ones who most need birth control and are most likely to "skip" it if it costs too much. Thirty dollars might not be much to you, but that's a lot to a high school student. Should she be having sex? That's not our business. Should she have a baby? Most definitely not.

I can't even discuss whatever you said about the 0.07%; 17,000 sounds like a lot of children to me. I guess those kids should stop "huffing junk food and exercise." If their "welfare moms" weren't such slackers -- buying TVs instead of antibiotics -- they would be alive today. I'm glad you took care of your baby brother when you were 17 and didn't need any training. I know how to sew; does that mean I should give my son stitches the next time he falls off his bike? No child should die because of lack of health insurance. Not one. Period. The end.

"Welfare mom" is not a pejorative. It is not code for some kind of loser. With the levels of unemployment in this country -- now beginning to turn around thanks to our president -- I know you don't assume every woman on welfare is there by choice. Thank God we have welfare. And we should have open, universal healthcare so anyone, regardless of her financial status, can go into the doctor for a regular checkup and whatever tests she needs.

When you talk to Canadians or Brits they might grumble about their systems -- mostly about waiting in line. But not one would give them up. They absolutely appreciate their ability to go to the doctor, the dentist, a specialist, whenever it's necessary. Most Americans want universal healthcare, and a majority thinks the federal government should provide it.